State of Vermont

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

STATE OF VERMONT

Doing business as

Vermont State Hospital

Practice address

103 South Main Street
Waterbury, VT 05671-9800

Phone

(802) 241-3009

Fax

(802) 241-1439

NPI assigned

Oct 17, 2006

Last updated

Apr 23, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Terry Rowe

Title

Executive Director

Phone

(802) 241-3100

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Vermont State Hospital Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215017678. Details of each certification follow.

• CCN 474003 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 474003

Legal name

VERMONT STATE HOSPITAL

Certification status

Terminated Involuntary: failure to meet health/safety requirements, Feb 9, 2005

Provider type (POS)

Hospital – Psychiatric

Participating since

Nov 24, 2004

Last certification

Nov 18, 2004

Beds

54

Ownership / control type

State

Facility address

103 South Main Street
Waterbury, VT 05671

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208908800000",
    "number": "1215017678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 SOUTH MAIN STREET",
            "city": "WATERBURY",
            "state": "VT",
            "postal_code": "056719800",
            "telephone_number": "802-241-3009",
            "fax_number": "802-241-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 SOUTH MAIN STREET",
            "city": "WATERBURY",
            "state": "VT",
            "postal_code": "056719800",
            "telephone_number": "802-241-3009",
            "fax_number": "802-241-1439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF VERMONT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2008-04-23",
        "status": "A",
        "authorized_official_last_name": "ROWE",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "802-241-3100",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "VT4000",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "474003",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "474002",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vermont State Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Heather Amber Shlosser, FNP
• Thomas A Simpatico, M.D.
• Gillian Lee Skovron, LICSW
• Chloe Smith, LICSW
• Sports & Family Chiropractic LTD
• State of Vermont - Department for Children & Families
• State of Vermont Disability Determination Services
• Navah S Stein
• Jeanne D Stern, MS CCC-SLP
• Thomas Albin Sturm, R.PH.

• Psychiatry Physician in Waterbury, VT
• Providers in Waterbury, VT by specialty
• Psychiatry Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.